| NPI | 1427119791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A063994) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 36161) |
| 1223P0106X Dentist Oral and Maxillofacial Pathology (Licence: CA 36161) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 36161) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: CA 63994) | |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: CA A063994) | |
| 2086S0127X Surgery Trauma Surgery (Licence: CA A063994) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2023-03-07 |